University of California San Francisco

Timed Toilet Training

Why do muscles need to be “trained”?

kid toiletCorrective surgery for imperforate anus places the colon through the pelvic muscles and the anal sphincters. These are striated muscles and are under voluntary control; however, a child needs to learn how to control them. Even adults may not be aware of how to consciously relax and contract the pubo-rectalis muscle.

What exercises are helpful?

There are 2 exercises to practice. The first is stopping and starting the urinary stream. The pelvic muscles that stop the urinary stream are the same muscles that stop a bowel movement. This can help develop awareness of the sensation of pelvic muscle contraction and relaxation. Thus, if the child practices stopping and starting the urinary stream regularly, it increases awareness and skill at voluntary control of this muscle. 

The second exercise is the contraction of the gluteus muscles, the “buttock squeeze”, which also causes the external anal sphincters to contract. Thus, doing the “buttock squeeze” increases the awareness and skill at voluntary control of this muscle. Parents must be aware of these exercises themselves in order to teach their child how to do the exercises.

What sensations can I expect my child to feel?

kid toilet in use 2When the rectum fills with stool and becomes distended, the child will feel a sensation of fullness. The pelvic muscles and anal sphincters can be consciously contracted. This will relieve the sensation of fullness and allow bowel control. Unfortunately, the feeling of fullness may not be present in some children with imperforate anus. If so, the child must learn to keep his pelvic muscles and anal sphincters contracted, or squeezed closed, at all times to avoid soiling. For these children without rectal sensation, soiling may be present at night because the sphincters do not remain contracted while asleep. If your child cannot control bowel movements, even with practicing these exercises, contact our office.

How does Timed Toilet Training help my child?

Staying clean is important to avoid teasing and bullying from peers. Since this depends on avoidance of accidents (soiling), a daily regimen of sitting down at the toilet twice a day, after breakfast and after dinner, is recommended. When successful, the rectum should be empty between the 2 timed bowel movements.

How long will this be necessary?

Parent awareness and patient education is the key to long term success. Colonic care will always be a part of their lives and laxatives and enemas will be normal for daily care.

What if my child continues to have soiling accidents at age 4, after much training?

Occasionally, there may be soiling in between the 2 timed bowel movements. This is evaluated by an abdominal X-ray, and treated with an adjustment in the laxative or enema therapy.